| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $345.42 | $500.00 | $935.00 | |
Hally Health
| Facility | $150.00 | $150.00 | $150.00 | |
Medica
| Facility | $2,560.00 | $2,560.00 | $4,000.00 | |
Oscar Health
| Facility | $572.00 | $604.00 | $753.00 | |
Wellmark
| Facility | $18,170.00 | $28,440.00 | $40,290.00 |